Senate health bill expected Thur., McConnell says; could stretch Medicaid expansion but then cut program more than House bill

By Al Cross and Melissa Patrick
Kentucky Health News

Senate Republicans plan to make their repeal-and-replace-Obamacare bill public on Thursday, Majority Leader Mitch McConnell of Kentucky told reporters Tuesday.

The bill is likely to continue the Medicaid expansion, which serves 470,000 Kentuckians, longer than the bill passed by the House, but could make deeper cuts to Medicaid in the long run.

McConnell talked and gestured as Republican Policy Committee

Chair John Barrasso of Wyoming, left, and Conference Chair

John Thune of South Dakota listened, while Republican Whip John

Cornyn of Texas looked away. (Associated Press photo : J. Scott Applewhite)

McConnell's announcement indicated that the bill is being analyzed by the Congressional Budget Office, which would clear it for debate, votes and perhaps passage on the Senate floor next week, meeting McConnell's goal of action before the July 4 week recess that begins Friday, June 30.

"I expect to have a discussion draft on Thursday, and we will go to the bill once we get a CBO score, probably next week," McConnell told reporters. Asked how long the Senate will have to review the bill, McConnell said "plenty of time."

On the floor Monday, Minority Leader Chuck Schumer of New York asked McConnell if the Senate would have more than 10 hours to debate the bill and McConnell wouldn't answer the question, saying only, "We'll have ample opportunity to read and amend the bill."

Schumer and other Democrats have been shut out of negotiations in the bill, which Republicans can pass with no Democratic votes because they are invoking budget rules that preclude a filibuster and bypass the 60-vote requirement to pass legislation.

McConnell said of Democrats, "They've made it clear they are not interested in helping" repeal Obamacare. Republicans plan no committee hearings on the bill, and note that Democrats passed Obamacare with only their own votes.

"No transparency would have been added by having hearings in which Democrats would have offered endless single-payer-system amendments," McConnell said. "That is not what this Senate was sent here to do."

McConnell's office is writing the bill, Republican Sen. Bob Corker of Tennessee told The Washington Times Monday: “The leader is really writing this bill. You can say the Finance Committee is, you could say the Budget Committee is, you could say the Health Committee is — but the leader’s office is writing the bill. And what they’re trying to do is sort of try to attempt hit the sweet spot between those differences that exist, which are natural when you have people from different states. I haven’t seen what that is yet, and to my knowledge no one has seen that yet.”

The Times reports, "Republican negotiators are still fine-tuning how make tax credits in their plan generous enough for certain cohorts, including the needy and older Americans who aren’t yet eligible for Medicare. Yet Sen. Rand Paul, Kentucky Republican, suggested his colleagues want to dole out more taxpayer assistance than the 2010 law they’re trying to scrap."

“One of the key things when it comes out, when we get a copy, is: Are there more subsidies in our bill than Obamacare?” Paul said. “That, to me, really is a non-starter.”

That could depend on what Paul calls a "subsidy." The word generally refers to tax credits and cost sharing for private insurance policies, but could also be applied to the heavy financial support that the 2010 health-reform law gives to states' expansion of the Medicaid program.

McConnell has suggested phasing out the Medicaid expansion through 2023, instead of ending it in 2020, but The Hill reports that the Senate bill could make deeper cuts to Medicaid in the long run: "According to lobbyists and aides, the proposal would start out the growth rate for a new cap on Medicaid spending at the same levels as the House bill, but then drop to a lower growth rate that would cut spending more."

That risks losing the votes of Republican senators such as Rob Portman of Ohio and Dean Heller of Nevada, and McConnell has only two votes to spare. If the vote is 50 to 50, Vice President Mike Pence can break the tie in favor of the Republicans.

"It may be too late to rally support . . . if reports coming out of a meeting of Republican senators are accurate, Rob Garver and Eric Pianin of The Fiscal Times report. "Sen.John Thune of South Dakota and Majority Whip John Cornyn [of Texas] exited a meeting of the Senate GOP caucus Tuesday afternoon and told reporters that there is currently no consensus among members on what the final version of the bill ought to look like." The writers add, "McConnell is the shrewdest politician on Capitol Hill and it would be a serious mistake to underestimate his ability to pull victory from the jaws of defeat."

McConnell "stopped short of guaranteeing that the bill would get the 50 Republican votes it would need to pass it when he brings it to the floor," notes Tierney Sneed of Talking Points Memo. McConnell replied, “We are going to make every effort to pass the bill that dramatically changes the current health-care law.”

The House Freedom Caucus, an ardently conservative group generally aligned with Paul, sent McConnell a letter warning him not to make bill too moderate. McConnell told reporters that the bill will be "a profound, positive improvement over the status quo."

Meanwhile, some lobbying groups expressed frustration at the inability to meet with McConnell. “It is deeply disturbing,” Erika Sward, assistant vice president of the American Lung Association, told the Los Angeles Times. “Patients groups like ours need to make sure that our patients’ needs for healthcare will be met. … We can’t do that if we can’t see what is being proposed.”

"Major physician groups, hospitals, consumer advocates and organizations representing millions of patients with cancer, diabetes, heart disease and other serious illnesses have been pleading with Republican leaders for months to open up the process and listen to their concerns," report Noam Levey and Lisa Mascaro of the Times. "This week, a group of more than 15 patients' groups . . . asked McConnell’s office to meet with them next week, proposing any time between Friday and June 22.

"A representative from McConnell’s office told them staff schedules were too busy, according to representatives of several of the organizations. McConnell spokesman Don Stewart said the majority leader’s schedule is full. 'Numerous meetings are already booked well in advance,' he said."

A group of 120 lobbies for consumer and health-care providers wrote McConnell a letter asking for the preservation of Medicaid, and the American Hospital Association said the Medicaid cuts being considered would have "serious negative consequences for communities across America."

Mike Rust, president and CEO of the Kentucky Hospital Association, told Kentucky Health News that the group has long taken two consistent positions: "Keep the expansion and if they repeal it, restore the cuts to Medicare" reimbursements, which were made when Medicaid was expanded.

Don Ritchie, historian emeritus of the Senate, told the Times that the Senate had not taken such a partisan, secretive approach to major legislation since said not since the years before World War I. That's when "Senate Democrats, at the urging of President Woodrow Wilson, drew up major tariff reforms while shutting out Republicans. But when Democratic leaders tried that again when they had large majorities during the Great Depression, rank-and-file senators revolted. It hasn’t happened since, he said."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.